International Journal of Clinical Oncology

, Volume 23, Issue 1, pp 81–91 | Cite as

The use of neoadjuvant therapy for resectable locally advanced thoracic esophageal squamous cell carcinoma in an analysis of 5016 patients from 305 designated cancer care hospitals in Japan

  • Yoichiro Tsukada
  • Takahiro Higashi
  • Hideaki Shimada
  • Yoshinori Kikuchi
  • Atsuro Terahara
Original Article



Recent studies have shown the benefits of neoadjuvant therapy with chemotherapy or chemoradiotherapy for resectable locally advanced thoracic esophageal squamous cell carcinoma (ESCC). The aim of our study was to elucidate the use of neoadjuvant therapy for thoracic ESCC in Japan.


Data on patients with stage IB–III thoracic ESCC were retrieved from the national database of hospital-based cancer registries combined with claims data between 2012 and 2013. These data were analyzed using a mixed-effect logistic regression analysis, with a focus on exploring patterns in the first-line treatment for ESCC, including proportion of patients who received neoadjuvant therapy, and investigating the hospital characteristics and patient factors associated with the use of neoadjuvant therapy.


Of the 5016 patients with stage IB–III thoracic ESCC at the 305 participating hospitals, 34.2% received neoadjuvant therapy (neoadjuvant chemotherapy, 29.5%; neoadjuvant chemoradiotherapy, 4.7%). The therapy was less likely to be administered to older patients (≤64 years, 48.8%; 65–70 years, 42.0%; 70–75 years, 33.9%; 75–80 years, 22.2%; 80–85 years, 3.8%; ≥85 years, 1.4%) and at hospitals with a low volume of patients (very high, 42.1%; high, 37.5%; low, 30.7%; and very low, 26.4%). This trend was confirmed by regression analysis.


Based on our results, in Japan, relatively few patients with resectable locally advanced thoracic ESCC receive neoadjuvant therapy, with older patients and patients at lower volume hospitals being less likely than other patients to receive the neoadjuvant therapy. We recommend that the process of treatment decision-making be assessed at both the patient and hospital levels so that patients can consider various treatment options, including neoadjuvant therapy with surgery in Japan.


Esophageal cancer Practice patterns Healthcare inequalities Registries Age Hospital volume 



We thank Kaoru Konno for her technical assistance for this project, as well as the participating hospitals that submitted insurance claim data. This work was supported by the National Cancer Center Research and Development Programs (Grant Number 28–A–21).

Compliance with ethical standards

Conflict of interest

No conflict of interest.

Supplementary material

10147_2017_1178_MOESM1_ESM.docx (48 kb)
Supplementary material 1 (DOCX 48 kb)


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Copyright information

© Japan Society of Clinical Oncology 2017

Authors and Affiliations

  1. 1.Division of Health Services Research, Center for Cancer Control and Information ServicesNational Cancer CenterTokyoJapan
  2. 2.Department of RadiologyToho University Omori Medical CenterTokyoJapan
  3. 3.Department of Clinical OncologyToho University Graduate School of MedicineTokyoJapan
  4. 4.Department of Surgery, Faculty of MedicineToho UniversityTokyoJapan
  5. 5.Division of Gastorenterology and Hepatology, Department of Internal Medicine, Faculty of MedicineToho UniversityTokyoJapan

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